Diabetes Flash

Question 1

Blood glucose levels to diagnose T2D.

Answer 1

> 7 mmol/L FPG. >11.1 OGT. >11.1 casual PG w/ symptoms. (polydipsia, uria, phagia)

Question 2

Drugs that cause dyslgycemias (5)

Answer 2

Atypical Antipsychotics, thiazides/loop diuretics, Beta blockers, steroids, HIV protease inhibitors.

Question 3

Long acting insulins (4)

Answer 3

Insulin NPH (humulin N, novolin NPH). Insulin detemir (levemir), insulin glargine (lantus)

Question 4

Short acting insulins (4)

Answer 4

Humulin R, Novolin Toronto, Insulin aspart (novorapid), insulin glulisine (apidra), insulin lispro (humalog)

Question 5

How to empirically start T1D on insulin, or switch T2D to insulin.

Answer 5

0.5 units/kg insulin. Split 40% (long acting HS) 60% (short acting split TiD with meals)

Question 6

How to add insulin to T2DM regimen

Answer 6

0.1-0.2 units/kg HS

Question 7

Mild Hypoglycemia occurs at what level, and what symptoms.

Answer 7

< 4.0 mmol/L Irritability, sweating, tremors, nausea, weakness.

Question 8

Severe hypoglycemia symptoms occur at what level and what symptoms.

Answer 8

< 2.8 mmol. Confusion, disorientation, coma.

Question 9

How to treat hypoglycemia, how much does this increase BG.

Answer 9

15g of CHO. Ie. 6 life savers, 1 cup of milk, 3/4 up OJ or soda.

Question 10

Treatment of T2D: what A1C do we start drug therapy immediately? Alternatively? How long to achieve new A1C targets?

Answer 10

> 9% - start 2 agents. <9% try exercise x 3months. Try to achieve target in 9-12months.

Question 11

The target FPG for T2D, the target post prandial PG. Target A1C. Target BP.

Answer 11

4-7mmol/L. 5-10 mmol/L. 7%. 130/80.

Question 12

Which insulins can you NOT mix.

Answer 12

Lantus (glargine). Levemir (detemir)

Question 13

T2D drug of choice in pregnancy. Alternative (2)

Answer 13

Insulin (SWITCH to this in most cases from oral agents. If unable to use insulin: Glyburide. Metformin.

Question 14

Insulins which are cloudy.

Answer 14

Insulin NPHs.

Question 15

The only sulfonylurea indicated in pregnancy.

Answer 15

Glyburide

Question 16

Sulfonylureas which are cleared renally (2)

Answer 16

Glyburide, Chlorpropamide

Question 17

Adverse effects of sulfonyl ureas.

Answer 17

Hypoglycemia. Weight gain. (sulfa skin rash?). Interacts with salicylates, MAOis, Azoles, (inhibit metabolism) to increase risk of hypoglycemia.

Question 18

Meglitinide drugs (brand/generic), dosage.

Answer 18

Repaglinide, Gluconorm. Nateglinide - Starlix. Take before meals, allows flexibility, because if skip a meal, can skip a dose (unlike gliclazide MR - where skipping meals is bad.)

Question 19

Meglitinides are cleared by.

Answer 19

Cyp 3A4 metabolism (not renally cleared)

Question 20

Acarbose Adverse effects.(2)
Contraindicated in. (1)

Answer 20

GI intolerance, (flatulence, diarrea, cramps) Liver failure
Inflammatory bowel disease.

Question 21

Oral Antihyperglycemic drugs that are weight neutral.

Answer 21

Acarbose, Metformin.

Question 22

Oral Antihyperglycemic drugs that are weight Negative

Answer 22

Liraglutide

Question 23

Oral Antihyperglycemic drugs that are weight Positive

Answer 23

Sulfonylureas, TZDs, meglitinides,

Question 24

DPP4 inhibitor drugs. Brand/generic. Adverse effects (1).

Answer 24

Januvia (sitagliptin), Onglyzza (saxagliptin), Nasopharyngitis (sore throat).

Question 25

Metabolism of DPP 4 inhibs (2)

Answer 25

Both renally eliminated. Sitagliptin no cyp interactions. Saxagliptin - Cyp3A4 interactions (sax gets around)

Question 26

TZD drugs (2) and adverse effects (2)

Answer 26

Rosiglitazone (avandia), pioglitazone (actos). Fluid retention (edema, CHF). Increased Fractures

Question 27

Oral antihyperglycemic drugs which are renally eliminated. (5) Those which are contraindicated in acute renal failure.(3)

Answer 27

Glyburide, Chlorpropamide, sitagliptin, saxagliptin, metformin. Metformin, glyburide, chlorpropamide.

Question 28

Adverse effects of GLP agonist. Contraindicated in. (2)

Answer 28

Liraglutide (victoza). Nausea/ vomiting/Diarrhea. Nasopharyngitis. Thyroid cancer. Pregnancy.